Along with the risk of drug dependence, the risk of drug abuse can develop other medical conditions and high mortality. In this regard, infections are one of the most serious complications associated with drug use, especially if they are administered parenterally. Among the infections developed by people who injects drugs, the HIV / AIDS has most influenced the morbidity and mortality in this population, because the population effectiveness of antiretroviral (ARV) treatment, compared with other HIV-groups, remains lower and this is due to a less use and adherence of ARV therapy.
Drug users are a different patient population group and together the instability resulting from drug-seeking behaviors, often show serious mental and social problems (poverty, marginalization) that can facilitate the acquisition and transmission of infectious diseases and hindering the treatment of its. Therefore, the study of infectious diseases in this population is of special interest, with the objective of improving medical care and monitoring the effectiveness of therapeutic measures established. The presentation of a doctoral thesis by compendium of articles provides the ability to evaluate different aspects of HIV/AIDS among drug users.
In the first article of this thesis the progressive use of ARV therapy in a cohort of drug users with HIV / AIDS in Barcelona and metropolitan area is described. However, it discontinuation of ARV therapy is a common situation and that a significant percentage of patients do not start ARV therapy despite being at an advanced stage of the disease
The second article compares the effectiveness of ARV therapy administered in an outpatient drug treatment and urban through comprehensive and multidisciplinary care including HIV care, treatment of drug dependence and psychosocial support, with standard care of HIV infection. The results indicate that the implementation of this program improves the effectiveness of ARV therapy getting similar results to sexually transmitted HIV-patients
In the third article, the high prevalence of prolonged QTc interval in HIV/AIDS patients undergoing methadone maintenance treatment and the risk factors associated with the onset of serious ventricular arrhythmia (Torsades de Pointes) is described by electrocardiography recording.
Finally, the last article describes the changes in the mortality associated with drug use disorders and alcohol in Barcelona and metropolitan area. Although mortality remains high in this population, a progressive mortality decrease is observed and that HIV / AIDS remains a major cause of mortality especially in patients with opioid dependence.
This thesis shows that, due to the diversity of clinical complications affecting these patients, the specialty of Internal Medicine covers the health care needs of this population and comprehensive patient care drug user by specialists in Internal Medicine is one of the objectives that the thesis defends and should be enhanced from the Internal Medicine specialty